第一跖趾关节成形术与第一跖趾关节融合术比较治疗类风湿前足畸形的Meta分析

E ectiveness of the First Metatarsophalangeal Joint Arthroplasty versus Arthrodesis for Rheumatoid Forefoot Deformity: A Meta-Analysis

目的系统评价第一跖趾关节切除成形术与第一跖趾关节融合术比较治疗类风湿前足畸形的临床疗效。方法计算机检索CNKI、Ovid、MEDLINE、CBM、EMbase、WanFang Data、The Cochrane Library(2012年第1期)以及康健循证医学知识仓库,查找第一跖趾关节切除成形术与第一跖趾关节融合术比较治疗类风湿前足畸形的随机对照试验(RCT),检索时间截至2012年2月。由2位研究者按照纳入和排除标准独立筛选文献、提取资料和评价质量后,采用RevMan5.1软件进行Meta分析。结果最终纳入4个RCT,共计206例患者(269只足),其中第一跖趾关节切除成形术组98例(130只足),第一跖趾关节融合术组108例(139只足)。Meta分析结果显示:第一跖趾关节融合术在穿鞋、外观的评分方面优于第一跖趾关节切除成形术,其差异均有统计学意义[穿鞋:MD=0.88,95%CI(1.55,0.22),P=0.01;外观:MD=5.04,95%CI(8.94,1.14),P<0.000 01];但两者在患者满意度、转移性病损、疼痛、日常及体育活动和拇趾区承重压力的评分方面,其差异均无统计学意义。结论第一跖趾关节融合术治疗类风湿前足畸形疗效优于第一跖趾关节切除成形术。受纳入研究质量的限制和可能存在发表偏倚的影响,上述结论尚需开展更多高质量的随机双盲对照试验加以验证。

Objective To evaluate the clinical effectiveness of the first metatarsophalangeal （MTP） joint arthro- plasty versus arthrodesis for rheumatoid forefoot deformity. Methods The randomized controlled trials （RCTs） about the first MTP joint arthroplasty vs. arthrodesis for rheumatoid forefoot deformity published by February 2012 were searched in the databases such as CNKI, Ovid, MEDLINE, CBM, EMbase, WanFang Data, The Cochrane Library （Issue 1, 2012）, and KJEBM. Two reviewers independently screened studies, extracted data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Then meta-analysis was conducted using RevMan 5.1 software. Results A total of 4 RCTs were included. Among total 206 （269 feet） patients involved in, 98 （130 feet） were in the ar- throplasty group, while the other 108 （139 feet） were in the arthrodesis group. The results of meta-analysis showed that the arthrodesis group was superior to the arthroplasty group in the footwear （MD=-0.88, 95%CI -1.55 to -0.22, P=0.01）, and the alignment （MD=-5.04, 95%CI -8.94 to -1.14, P〈0.000 01） with significant differences. But there were no significant differences between the two groups in patient satisfaction, metastatic lesions, pain, activity and weight-bearing of Hallux. Conclusion Based on the current studies, arthrodesis is superior to arthroplasty in treating rheumatoid forefoot deform- ity. For the quality restrictions and possible publication bias of the included studies, more double blind, high quality RCTs are required to further evaluate the effects.